New Patient Information & Forms

Dr. Moore is currently a participating provider with Blue Cross Blue Shield, United Healthcare, Harken Health, Coventry Health Care, Golden Rule Insurance, and Medicare.

Dr. Moore is in the Blue Cross Blue Shield HMO, IF you have an Advocate Provider. You MUST get a referral from your Primary Care Provider before scheduling your appointment. Without a referral, you will be responsible for payment of your visit(s).

INSURANCE PROCEDURE:

Please call the information phone number located on your insurance card for insurance benefits for chiropractic benefits.

Please Click Here For Insurance Coverage Instructions & Additional Insurance Information.

ATTENTION: Please contact the office before filling out these forms.

The 4 forms below can be completed at any time BEFORE your scheduled visit:

The forms below (that you were instructed to fill out) should be completed ON THE DAY of your scheduled visit, so that they will be current.

REMINDER: Bring Insurance Card the Day of your Initial Visit.

 

The following Information should be brought if your case is related to an Auto Accident:

  • Insurance Information (Both Party at Fault and Personal)
  • Claim Number
  • Police/Accident Report
  • Any Emergency Room documents pertaining to incident (If Applicable)
  • Any X-rays, MRI, Radiology, etc. Reports (If Applicable)

 

The following Information should be brought if your case is related to a Personal Injury:

  • Insurance Information (Both Party at Fault and Personal)
  • Claim Number
  • Accident Report (if any)
  • Any Emergency Room documents pertaining to incident (If Applicable)
  • Any X-rays, MRI, Radiology, etc. Reports (If Applicable)

 

The following Information should be brought if your case is related to a Workers Compensation:

  • Employer Information (Supervisor Contact info)
  • Claim Number & Date of Incident
  • Any Emergency Room documents pertaining to incident (If Applicable)
  • Any X-rays, MRI, Radiology, etc. Reports (If Applicable)